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Khalil AF, Badr HI, Zaher A, Elshirbiny MF, Elnaggar AM, Badran M, Zayed AE, Abdelhalim MM, Amen MM. Repair of spina bifida cystica: an institutional experience. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Abstract
Objective
Although most cases with spina bifida cystica could be closed by primary skin closure with or without undermining its edges, about 25% of patients have large defects not amenable for closure by these simple methods. We conducted this study to review our techniques in closing spina bifida cystica defects.
Methods
We retrospectively reviewed the data of consecutive 21 patients diagnosed with spina bifida cystica in our setting. According to the surface area of the defect, the approach was decided; primary closure for small defects (11 cases) and flap-based approach for large defects (10 patients).
Results
The age of the included pediatric patients ranged between 3 and 75 days. For the primary closure cases, a vertical incision was done in seven cases. For the flap-based group, bilateral rotation transposition flap was done for circular defects (7 cases) while elliptical ones were repaired via bilateral V–Y flap. Complete skin healing was achieved after two weeks (range 12–18 days) in most cases. Complications were as follows; for the primary closure group, cerebrospinal fluid leakage (18.18%%), partial wound dehiscence (18.18%) and superficial surgical site infection (9.09%). In the flap-based group, CSF leakage (20%), superficial surgical site infection (10%), and distal flap necrosis (30%) were detected. Reoperation for wound complication was needed only in one case in the flap-based group.
Conclusions
Flap-based procedures are recommended for patients with large spina bifida cystica defects because of less tissue dissection and low complication rates. Primary closure should be kept for small defects.
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Closure of meningomyelocele defects using various types of keystone-design perforator island flaps. Arch Plast Surg 2021; 48:261-268. [PMID: 34024070 PMCID: PMC8143945 DOI: 10.5999/aps.2020.01326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/12/2021] [Indexed: 11/08/2022] Open
Abstract
Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap. Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps. Results The median age of the patients at surgery was 10.5 days (range, 1–369 days) and the average defect size was 22.5 cm2 (range, 7.1–55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45–120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects. Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.
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Donaldson C, Murday HKM, Gutman MJ, Maher R, Goldschlager T, Xenos C, Danks RA. Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 2018; 34:733-736. [PMID: 29255922 DOI: 10.1007/s00381-017-3697-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/12/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE We have previously reported a small series on the closure of large myelomeningocele (MMC) defects with a keystone design perforator island flap (KDPIF) in a paediatric neurosurgical centre in Australia. We are now presenting an updated longer term follow-up of an expanded series demonstrating longer term durability of this vascularized flap for large myelomeningocele defects. METHODS The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2016. Retrospective analysis of the neurosurgical database revealed an additional three patients who underwent KDPIF closure at the Monash Medical Centre for MMC repair at birth. RESULTS Wound healing was satisfactory in all six cases. With delayed follow-up, there was no associated skin flap separation, skin flap dehiscence, skin flap necrosis, cerebro-spinal fluid leak, however two infections were encountered, both resolved with conservative management including antibiotics and simple washout. CONCLUSION In this expanded case series with increased longevity of follow-up, the keystone design perforator island flap remains a robust alternative for closure of large myelomeningocele defects.
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Affiliation(s)
- Christopher Donaldson
- Department of Neurosurgery, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia.
| | - Hamsaveni K M Murday
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew J Gutman
- Department of Neurosurgery, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Rory Maher
- Department of Plastic Surgery, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Chris Xenos
- Department of Neurosurgery, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - R Andrew Danks
- Department of Neurosurgery, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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